ADM SYSTEM of CARE & Client’s Rights Chris Freeman-Clark, MPA, LISW-S Coordinator of Forensic Services Co-Chair SC Hoarding Task Force Sept 19, 2019
“Successful, long term recovery is built on a foundation of hope.” 2017 Report to the Community, Summit County ADM Board
Hopeful
Hopeless “SUBJECT NAKED IN STREET AND VERY DELUSIONAL. SUBJECT SAID HE WANTED TO DIE BY GETTING RUN OVER SO "IT" WOULD HAPPEN.” - CIT Narrative
Hopeless “Officers dispatched… ref fight between girlfriend and boyfriend. Subject 2 blocks from her home… wearing tank top and barefoot..temperature around 0. She was crying…states she cut her leg earlier to make herself bleed…has thoughts of suicide..she was raped at 5 years old..tonight took 2 Vicoden and 5-7 beers.” APD CIT Jan 2010
The ADM System of Care offers… …Hope through timely access to treatment - 2017 ADM Report to the Community
Timely Access PAST PRESENT Central Assessment: 50 days avg from call Decentralized assessment: most common to assessment wait is one day No follow up system for opiate QUICK RESPONSE TEAMS (9 TEAMS) overdoses > lots of overdose > follow up team contact within a week treatment > overdose/or death decreases cycling and intervenes when motivation is highest ; Naloxone distribution Northcoast Forensic Discharges – 3 to 4 months 6-7 months
Treatment: but not just any kind of treatment: • Evidence based (studied, scientifically validated) • Cost Effective (for participant and tax payers • Minimally invasive (see Client’s Rights)
Evidenced Based Practice: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual (patient/client/consumer).” - Dr. David Sackett
EBP Fidelity and Outcomes • Is the EBP being implemented in the way that it was designed? • ADM Fidelity Reviews/ Dr. Ellington • Are we getting the expected + outcomes from implementation of the EBP?
How does Summit County offer hope through timely access to treatment?
Summit County ADM Board plans November renewal levy ... https://www.ohio.com › news › 20190508 › summit-county- adm-board-pl... • The levy would be used for mental health and recovery programs for children, adults and families in the county and for the acquisition, … By Beacon Journal /Ohio.com. Wednesday. Posted May 8, 2019 at 11:09 PM Updated
Local property tax levy funds 78% of ADM Board disbursements. (BALANCE= PRIMARIL Y S T AT E/ FED)
Some AGENCIES/AFFILIATIONS
ADM Board responsibilities: • Plan and identify service gaps • Distribute $$$ • Coordinate, collaborate, facilitate • Measure
MENTAL HEALTH UNIT SCJ MUNI AND (SPA ) CSS CP COURTS ADM NORTHCOAST ORIANA HOSPITAL HOUSE
Past Service Gaps: PAST SERVICE GAPS First responders’ knowledge base re: SPMI High incarceration rate for SPMI clients Hoarded homes identified very late or not at all Rising opiate overdoses leading to deaths
Past Service Gaps: PAST SERVICE GAPS ADM Response First responders’ knowledge base re: CIT and education improved knowledge base SPMI High incarceration rate for SPMI Length decreased; quick hospitalizations = clients fewer bed days; MH Courts Hoarding individuals unidentified - Hoarding Task Force; Hoarding education; (approx 22,000 in county); Hoarding Conference; Partnerships w Health service/expensive very late Dept; early intervention focus Rising opiate overdoses leading to - Awareness campaigns; overhaul assessment deaths process; increased bed funding; Opiate Task Force; naloxone education and kit distribution
Evidenced Based Practice: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual (patient/client/consumer).” - Dr. David Sackett
Some Evidenced Based Interventions • CET - C ognitive E nhancement T herapy • CBT - C ognitive B ehavior T herapy • PAX Good Behavior Games • Mental Health Courts • Drug Courts • Medication
Client Rights see OAC 5122-26-18 Every individual is protected by a system of rights. Some: treated with consideration, respect for personal dignity, autonomy and privacy. To be treated in the least restrictive, feasible environment A listing of those rights is provided in your CIT Manual.
Client Rights A listing of those rights is provided in your CIT Manual. Problem? Caseworker > Supervisor > Dept. Director > Agency Client’s Rights Coordinator > ADM Client’s rights coordinator (HOLLY CUNDIFF) 330-564-4087 HCUNDIFF@ADMBOARD.ORG > Ohio Dept. of Mental Health & Addiction Services
WHO to call? CSS: Bruce Winer 330-253-9388 x461 Bruce.Winer@cssbh.org Portage Path: Adam Kulesza - 330-253- 3100 x1229 Akulesza@portagepath.org ADM: Holly Cundiff - (330) 564-4087 hcundiff@admboard.org
Contact with SPMI residents • Behaviorally descriptive is good; quotes are good. (specific unusual behaviors, dress, behavior, mood, speech, non-verbals) • Do you have a case manager (“community rehabilitation specialist” or CRS? (or SSA) • Where do you get your medicine? Do you get shots for your medicine?
Competency- Unrestored? • For F3,4,5 and Misdemeanors: If unrestored, Dismiss or File Affidavit in Probate, then dismiss criminal charge • For incompetency: (1) must have mental disease or defect; (2) symptoms from (1) impede ability to understand the charges, or, assist defense
How often is an NGRI Defense raised in felony cases? • 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8
How often is an NGRI Defense successful in felony cases? • 57% 5 • 40 3 • 31 1 • 22 .33% • 20 • 15 • 12 • 8.8
How often is an NGRI Defense raised in felony cases?
How often is an NGRI Defense successful in felony cases?
49 NGRI or ISTU-CJ clients 12 ISTUCJ and 37 NGRI 12 Female and 37 Male 1 Year (shortest) LIFE (longest) n=8 21 Hospital or DD Center 19 - Conditional Release (18 in Summit County)
As an attorney why would I,or not, encourage an NGRI defense?
Conditional Release • Common orders: • Medication compliance • 24/7 Supervised housing at discharge • No criminal activity • No drugs, alcohol • No out of state travel • Suzanne Hopper Act Registry (Form 95)
Success?? “Most of the problems come when we don’t have anything to do. Keep us busy!” - Consumer Lisa Marie Griffin CIT training, 9/18/18 On CR, violence risk and recidivism factors are assessed and protective factors are encouraged.
Violence Risk Assessment • 10 Historic Risk Factors • 5 Clinical • 5 Future • Increases Risk Lowers Risk • Command halluc A+ family • Fixed delusions Compliant • ANY drug/ETOH use Work/busy • Antisocial Min. viol hx
LOWER RISK HIGHER RISK - Early detection and treatment - Years without treatment - Later onset of symptoms - Early onset of psychosis - Accepting of Injectable meds and - Intolerant of injectable meds tolerant - Supportive, high mental health IQ - Dysfunctional family; poor Family and friends understanding of mental illness; member with serious mental illness - Female, older - Male, young - Drug/alcohol abstinence - Drug use esp difficult to detect (cocaine, alcohol , new drugs - HS completion + successful work hx - No vocational ability, poor work history, - No antisocial; no antisocial friends - Antisocial PD + Antisocial friends
Successes • 1. Most on CR have dramatic decrease in criminal activity • 2. We tend to catch decompensation early • 3. John, 20 hour manager at Panera • 4. Mary, ¾ time at restaurant for 10 years • 5. Sean, 20 years public library job
Resources for CIT First Responders • Https://namisummit.org • https://nami.org • https://www.nimh.gov • https://samhsa.gov
QUESTIONS??
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